• We cannot continue on our current course without depriving other societal domains that are essential to the long-term wellbeing of our community, such as education, physical infrastructure, aged care, environmental protection, the arts and recreation
• When we eventually do act we will realise that there are a limited number of ways to constrain the proportion of community resources expended on health care.

  One is for funders to pay less for the things that are done.

  The second, and perhaps the simplest, is to not do things that are of little or no benefit. We could also ensure that, when there is a choice, the less expensive options are used. This is primarily a task for doctors but everyone is responsible.

  The third is to make sure that people do not have treatment that they do not want. This merely supports the right of people to make a choice not to start or persist with treatment that will not bring them sufficient benefit in terms of a quantity of a life of quality as they define it. This also requires community acceptance that individuals have the right to make such choices.

While thoughtful medical practice, systemic support of the right to individual choice and improved efficiency can buy us some time they are unlikely to be sufficient.

Perhaps the complex ecology of gridlocked self-interest means that struggling health systems must collapse and fail before they can be rebuilt, and we will just have to watch while it happens.

Surely a better outcome would be to work towards spending only what we can afford. These are not simple issues and the process might begin with an open discussion of our community values and the goals of health care. The sooner we start that discussion the better.

From: https://www.mja.com.au/insight/2013/47/will-cairns-hard-choices